Provider Demographics
NPI:1528730876
Name:AXIVA INFUSION CENTERS - PN LLC
Entity type:Organization
Organization Name:AXIVA INFUSION CENTERS - PN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-955-0920
Mailing Address - Street 1:3420 FAIRLANE FARMS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8701
Mailing Address - Country:US
Mailing Address - Phone:561-955-0920
Mailing Address - Fax:844-440-0101
Practice Address - Street 1:10 ROUTE 31 N STE 103
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1606
Practice Address - Country:US
Practice Address - Phone:844-442-9482
Practice Address - Fax:844-440-0101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIVA INFUSION CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy